Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44

Intraocular Infection Intraocular Tumors 859

The prognosis of CMV retinitis depends on location of the disease.

Involvement of the optic nerve or macula leads to profound visual

loss. Unless the immune system is reconstituted, the ultimate prog-

nosis is very poor. With immune reconstitution, prognosis can be

very favorable. Complications include retinal detachment, cataract

and immune reconstitution uveitis.

Intraocular Tumors...................................

DEVRON H. CHAR, MD

history & physical

■Asymptomatic; decreased vision; rarely unilateral cataract, or painful

red eye.

tests

■Most diagnosed with non-invasive tests

■Intraocular lymphoma may be diagnosed by vitrectomy cytology.

■Retinal angioma patients should have a molecular genetic test for

VHL.

differential diagnosis

■Intraocular tumors are rare.

■An apparent intraocular tumor is more likely hemorrhage asso-

ciated with an idiopathic age-related macular degeneration or a

localized choroidal hemorrhage (hypertension or after recent eye

sugery).

■Other benign conditions including scleritis can simulate an ocular

malignancy.

■Most common primary intraocular neoplasm in ambulatory adults

is uveal melanoma (incidence of∼7/1,000,000/year); mainly older

Caucasians.

■<1% of uveal melanomas present simultaneously with detectable

metastases.

■Metastases to the choroid can be the first sign of a systemic malig-

nancy.

■∼10% of breast choroid metastases present before discovery of pri-

mary tumor.

■∼90% of renal or lung patients have diagnosis of ocular tumor prior

to discovery of primary lesion.

■Metastases non-pigmented; clinical and ancillary imaging usually

diagnostic